| Abstract | Karcinom prostate je najčešći zloćudni tumor u muškaraca. Radi se o zloćudnoj promjeni žlijezda prostate koja se javlja u starijoj životnoj dobi. Najveći broj pacijenata čine muškarci stariji od 70 godina. Dokazani su pojedini čimbenici rizika za oboljevanje od ove bolesti, kao što su dob, genetska predispozicija, kronična upalna stanja, rasa i etnička pripadnost. Bolest se širi lokalno, u lokalne i udaljene limfne čvorove te hematogeno u druge organe, najčešće kosti. Dijagnosticira se digitorektalnim pregledom, serumskim vrijednostima PSA i transrektalnim ultrazvukom vođenom biopsijom prostate. Pri procjeni proširenosti bolesti koriste se CT, MR, scintigrafija skeleta i PET-CT.
Stupnjevanje po Gleasonu je danas najpriznatiji sustav stupnjevanja izgleda neoplastičnih žlijezda prostate kojim se određuje tzv. primarni i sekundarni gradus tumora, a njihov zbroj predstavlja tzv. Gleasonov zbroj. Gleasonov zbroj je jedan od najbitnijih prognostičkih faktora karcinoma prostate. Sam za sebe nije pouzdan, ali u sklopu drugih faktora, kao što su dob i opće stanje bolesnika, klinički stadij i serumske vrijednosti PSA, predstavlja jednu od osnova za donošenje terapijskih odluka.
Ciljevi ovog rada su bili usporediti Gleasonov zbroj (GZ) u bioptičkim i operativnim uzorcima pacijenata koji su liječeni u KBC-u Split u razdoblju od 2005. do 2009. godine zbog karcinoma prostate, odrediti udio pacijenata koji imaju isti GZ u bioptičkom i operativnom uzorku, ali različit primarni i sekundarni gradus, odrediti udio pacijenata s GZ 2 do 4 u bioptičkom uzorku te postotak podudarnosti bioptičkog i operativnog uzorka, odrediti udio pacijenata s GZ 6 i manjim od 6 u bioptičkom uzorku i izračunati postotak podudarnosti bioptičkog i operativnog uzorka.
Istraživanje je provedeno analizom patohistoloških nalaza bioptičkih i operativnih uzoraka nakon radikalne prostatektomije u 214 pacijenata s karcinomom prostate koji su liječeni u KBC-u Split u razdoblju od 2005. do 2009. godine zbog karcinoma prostate. Patohistološki nalazi su dobiveni iz baze podataka Kliničkog odjela za patologiju, Kliničkog zavoda za patologiju, sudsku medicinu i citologiju KBC-a Split. Dobiveni podaci su obrađeni metodama deskriptivne statistike i prikazani grafički.
Postotak pacijenata koji imaju isti GZ u bioptičkim i operativnim patohistološkim uzorcima je 44,4%, 41,1% pacijenata ima veći GZ u operativnim uzorcima, dok 14,5% pacijenata ima manji GZ u operativnim nego u bioptičkim uzorcima. U ovom radu je određen broj pacijenata s istim GZ u bioptičkom i operativnom uzorku, a različitim primarnim i sekundarnim gradusom. Od 14 takvih slučajeva, 50% pacijenata pokazuje bioptički Gleasonov zbroj 3+4=7 te operativni GZ 4+3=7. Istraživanja na ovu temu još nema, no s obzirom da se radi o najčešćem Gleasonovom zbroju, ovi slučajevi se mogu pribrojiti subjektivnosti patologa pri procjeni uzorka i lokalizaciji s koje se uzimaju bioptički uzorci. 87% pacijenata s bioptičkim GZ 2 do 4 u operativnom uzorku ima veći GZ. Ovi rezultati govore u prilog ISUP konsenzus konferenciji 2005. godine gdje je donesen zaključak da se GZ 2 do 4 ne bi trebao koristiti u bioptičkom uzorku. 70% pacijenata s GZ manjim od 6 u bioptičkom uzorku ima veći GZ u operativnom uzorku. |
| Abstract (english) | Prostate cancer is the most common malignancy in men. It is a neoplastic change of the prostate glands that occurs in the elderly. The majority of patients are men older than 70 years. There are proven individual risk factors for developing this disease, such as age, genetic predisposition, chronic inflammatory conditions, race and ethnicity. The disease spreads locally, in local and distal lymph nodes and hematogenous in other organs, most commonly the bones. It is diagnosed by digital rectal examination, serum PSA and transrectal ultrasound guided biopsy of the prostate. The extent of the disease is determined by CT, MRI, bone scintigraphy and PET-CT.
Gleason score is the most used staging system of neoplastic prostate glands which determines so-called primary and secondary tumor grade, and their score represents so-called Gleason score. Gleason score is one of the most important prognostic factors of prostate cancer. With other factors, such as age and general condition of the patient, clinical stage, and serum levels of PSA, Gleason score is one of the foundations for making treatment decisions.
The objectives of this study were to compare the percentages in correspondence of Gleason score in biopsies and operational patterns of patients treated in hospital in Split from 2005 to 2009, indicate patients who have the same Gleason score in the biopsy and operating sample, but different primary and secondary grade of the samples, calculate the percentage of patients with Gleason score that was 6 and less than 6 in the biopsy sample and show the percentage of concordance of biopsy and operating samples.
The study was conducted by analyzing histopathological biopsy and operational samples after radical prostatectomy in 214 patients with prostate cancer who were treated at the hospital in Split in the period from 2005 - 2009, due to prostate cancer. Histopathological findings are obtained from the database of the Clinical Department of Pathology, Clinical Institute of Pathology, Forensic Medicine and Cytology, Split Hospital. The obtained data were analyzed by descriptive statistics and presented graphically.
The percentage of patients who have the same Gleason score in biopsy and operative histology samples is 44.4%, 41.1% of patients have a higher Gleason score in operating samples than in biopsy samples, while 14.5% have lower Gleason score in operating than in biopsy samples. This study has shown the number of patients with the same Gleason score in the biopsy and operating sample with a variety of primary and secondary grade. Out of 14 such cases, 50% of them have Gleason score 3 + 4 = 7 in biopsy and 4 + 3 = 7 in the operating sample. There are no researches on this subject yet, but given that this is most frequent Gleason score, these cases can be added to the subjectivity of the pathologist in evaluating the sample and localization of biopsy samples. 87% of patients with biopsy Gleason score 2-4 show higher Gleason score in operating sample. These results speak in favor of ISUP conference of 2005 where a decision was reached that the Gleason score 2-4 should not be used in a biopsy sample. 70% of patients with Gleason score less than 6 in the biopsy sample show higher Gleason score in operating sample. Biopsy samples with Gleason score 6 or less than 6 show 45% concordance with the operating samples. These results support the recommendation that the patterns 1 and 2 should not be used in the evaluation of biopsy samples. |
